BACKGROUND: Liver transplantation for unresectable hepatocellular carcinoma yields disappointing results. Most cases recur within 2 years, often in the transplanted liver. METHODS: A combination of neoadjuvant doxorubicin and orthotopic liver transplantation was used in 20 patients with unresectable hepatocellular carcinoma confined to the liver. Seventeen patients had tumors > 5 cm in greatest diameter, and 11 cases were stage IVA by the TNM classification. Doxorubicin was administered preoperatively, intraoperatively, and postoperatively at a dose of 10 mg/m2 weekly, totaling 200 mg/m2. RESULTS: Chemotherapy was well tolerated although leukopenia was observed in 70% of patients. Eight patients died, five of recurrent tumor and three of hepatitis B. Three others remain alive 8-22 months after tumor recurrence. One patient had initial tumor recurrence in the allograft. Actuarial survival is 59% and tumor-free survival is 54% at 3 years. For the 17 patients with tumors > 5 cm, overall survival is 63% and tumor-free survival is 49% at 3 years. CONCLUSION: The results of this pilot study suggest that neoadjuvant doxorubicin chemotherapy favorably alters the post-transplant survival of patients with hepatocellular carcinoma.
BACKGROUND: Liver transplantation for unresectable hepatocellular carcinoma yields disappointing results. Most cases recur within 2 years, often in the transplanted liver. METHODS: A combination of neoadjuvant doxorubicin and orthotopic liver transplantation was used in 20 patients with unresectable hepatocellular carcinoma confined to the liver. Seventeen patients had tumors > 5 cm in greatest diameter, and 11 cases were stage IVA by the TNM classification. Doxorubicin was administered preoperatively, intraoperatively, and postoperatively at a dose of 10 mg/m2 weekly, totaling 200 mg/m2. RESULTS: Chemotherapy was well tolerated although leukopenia was observed in 70% of patients. Eight patients died, five of recurrent tumor and three of hepatitis B. Three others remain alive 8-22 months after tumor recurrence. One patient had initial tumor recurrence in the allograft. Actuarial survival is 59% and tumor-free survival is 54% at 3 years. For the 17 patients with tumors > 5 cm, overall survival is 63% and tumor-free survival is 49% at 3 years. CONCLUSION: The results of this pilot study suggest that neoadjuvant doxorubicin chemotherapy favorably alters the post-transplant survival of patients with hepatocellular carcinoma.
Authors: W Scott Helton; Adrian Di Bisceglie; Ravi Chari; Myron Schwartz; Jordi Bruix Journal: J Gastrointest Surg Date: 2003 Mar-Apr Impact factor: 3.452
Authors: Marvin J Stone; Billie E Aronoff; W Phil Evans; Joseph W Fay; Z H Lieberman; Carolyn M Matthews; George J Race; R Pickett Scruggs; C Allen Stringer Journal: Proc (Bayl Univ Med Cent) Date: 2003-01
Authors: B Philosophe; P D Greig; A W Hemming; M S Cattral; I Wanless; I Rasul; N Baxter; B R Taylor; B Langer Journal: J Gastrointest Surg Date: 1998 Jan-Feb Impact factor: 3.452
Authors: Charles H Cha; Leyo Ruo; Yuman Fong; William R Jarnagin; Jinru Shia; Leslie H Blumgart; Ronald P DeMatteo Journal: Ann Surg Date: 2003-09 Impact factor: 12.969